Medical robotic system providing an auxiliary view of articulatable instruments extending out of a distal end of an entry guide

ABSTRACT

A medical system may comprise a display and a processor configured to determine an optimal position for an image capturing instrument to view working ends of a plurality of medical instruments when the plurality of medical instruments and the image capturing instrument are each extending out of a distal end of an entry guide. The processor may also be configured to cause the optimal position to be displayed on the display along with an image captured by the image capturing instrument of the working ends of the plurality of medical instruments.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.12/163,087 (filed Jun. 27, 2008), which is incorporated herein byreference.

FIELD OF THE INVENTION

The present invention generally relates to medical robotic systems andin particular, to a medical robotic system providing an auxiliary viewof articulatable instruments extending out of a distal end of an entryguide.

BACKGROUND OF THE INVENTION

Medical robotic systems such as teleoperative systems used in performingminimally invasive surgical procedures offer many benefits overtraditional open surgery techniques, including less pain, shorterhospital stays, quicker return to normal activities, minimal scarring,reduced recovery time, and less injury to tissue. Consequently, demandfor such medical robotic systems is strong and growing.

One example of such a medical robotic system is the da Vinci® SurgicalSystem from Intuitive Surgical, Inc., of Sunnyvale, Calif., which is aminimally invasive robotic surgical system. The da Vinci® SurgicalSystem has a number of robotic arms that move attached medical devices,such as an image capturing device and Intuitive Surgical's proprietaryEndoWrist® articulating surgical instruments, in response to movement ofinput devices by a surgeon viewing images captured by the imagecapturing device of a surgical site. Each of the medical devices isinserted through its own minimally invasive incision into the patientand positioned to perform a medical procedure at the surgical site. Theincisions are placed about the patient's body so that the surgicalinstruments may be used to cooperatively perform the medical procedureand the image capturing device may view it without their robotic armscolliding during the procedure.

To perform certain medical procedures, it may be advantageous to use asingle entry aperture, such as a minimally invasive incision or anatural body orifice, to enter a patient to perform a medical procedure.For example, an entry guide may first be inserted, positioned, and heldin place in the entry aperture. Instruments such as an articulatablecamera and a plurality of articulatable surgical tools, which are usedto perform the medical procedure, may then be inserted into a proximalend of the entry guide so as to extend out of its distal end. Thus, theentry guide provides a single entry aperture for multiple instrumentswhile keeping the instruments bundled together as it guides them towardthe work site.

Since the entry guide generally has a relatively small diameter in orderto fit through a minimally invasive incision or a natural body orifice,a number of problems may arise while teleoperating the surgical tools toperform the medical procedure and the camera to view it. For example,because the camera is bundled with the surgical tools, it is limited inits positioning relative to the surgical tools and consequently, itsview of the surgical tools.

Thus, although the tips of the articulatable surgical tools may be keptin the field of view of the camera, controllable linkages whichfacilitate the articulatability of the surgical tools may not be in thefield of view of the camera. As a consequence, the controllable linkagesof the surgical tools may inadvertently collide with each other (or witha link of the camera) during the performance of a medical procedure andas a result, cause harm to the patient or otherwise adversely impact theperformance of the medical procedure.

Also, since the articulatable camera is generally incapable of viewingits own controllable linkage, operator movement of the camera isespecially a concern where collisions with the surgical tool links areto be avoided. Further, when intuitive control is provided to assist theoperator in teleoperatively moving the surgical tools and camera, themotions of the linkages required to produce such intuitive motions ofthe tips of the tools and camera may not be obvious or intuitive to theoperator, thus making it even more difficult for the operator to avoidcollisions between linkages that are outside the field of view of thecamera.

OBJECTS AND BRIEF SUMMARY

Accordingly, one object of one or more aspects of the present inventionis a method that provides an auxiliary view to an operator to assist theoperator in performing a medical procedure on a patient using a medicalrobotic system having articulatable instruments extending out of adistal end of an entry guide inserted through a single entry aperture inthe patient.

Another object of one or more aspects of the present invention is amethod implemented in such a medical robotic system that provides avisual indication to an operator that indicates when controllablelinkages of the articulatable instruments may collide.

Another object of one or more aspects of the present invention is amethod implemented in a medical robotic system that provides a visualindication to an operator that indicates when joints and/or links and/orportions thereof of the articulatable instruments are nearing anundesirable or desirable event or condition.

Another object of one or more aspects of the present invention is amethod implemented in such a medical robotic system that improves anoperator's understanding of the configuration of the linkages of thearticulatable instruments that are outside of the field of view of acamera.

These and additional objects are accomplished by the various aspects ofthe present invention, wherein the embodiments of the invention aresummarized by the claims that follow below.

Additional objects, features and advantages of the various aspects ofthe present invention will become apparent from the followingdescription of its preferred embodiment, which description should betaken in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a top view of an operating room employing a medicalrobotic system utilizing aspects of the present invention.

FIG. 2 illustrates a block diagram of components for controlling andselectively associating device manipulators to left and righthand-manipulatable input devices in a medical robotic system utilizingaspects of the present invention.

FIGS. 3-4 respectively illustrate top and side views of an articulatablecamera and a pair of articulatable surgical tools extending out of adistal end of an entry guide as used in a medical robotic systemutilizing aspects of the present invention.

FIG. 5 illustrates a perspective view of an entry guide and its fourdegrees-of-freedom movement as used in a medical robotic systemutilizing aspects of the present invention.

FIG. 6 illustrates a cross-sectional view of an entry guide withpassages defined therein that extend between its proximal and distalends as used in a medical robotic system utilizing aspects of thepresent invention.

FIG. 7 illustrates a block diagram of interacting components of an entryguide manipulator as used in a medical robotic system utilizing aspectsof the present invention.

FIG. 8 illustrates a block diagram of interacting components of anarticulatable instrument manipulator and an articulatable instrument asused in a medical robotic system utilizing aspects of the presentinvention.

FIG. 9 illustrates a flow diagram of a method for providing a computergenerated auxiliary view, utilizing aspects of the present invention.

FIG. 10 illustrates a data and processing flow diagram to determineinstrument link positions and orientations using instrument jointpositions and forward kinematics, as used in a medical robotic systemutilizing aspects of the present invention.

FIG. 11 illustrates a data and processing flow diagram to determineinstrument joint positions using a sensed instrument tip position andinverse kinematics, as used in a medical robotic system utilizingaspects of the present invention.

FIGS. 12-13 respectively illustrate top and side auxiliary views asgenerated and displayed on a display screen by a method implemented in amedical robotic system utilizing aspects of the present invention.

FIG. 14 illustrates top and side auxiliary views as generated anddisplayed in separate windows on a display screen by a methodimplemented in a medical robotic system utilizing aspects of the presentinvention.

FIG. 15 illustrates an auxiliary view displayed adjacent to an imagecaptured by the articulatable camera on a monitor in a medical roboticsystem utilizing aspects of the present invention.

FIG. 16 illustrates an auxiliary side view of an articulatable camerahaving a frustum as generated and displayed by a method implemented in amedical robotic system utilizing aspects of the present invention on adisplay screen.

FIG. 17 illustrates a combined display of an auxiliary view of a pair ofarticulatable surgical tools from a viewing point of a camera, alongwith an image captured by the camera, as generated and displayed by amethod implemented in a medical robotic system utilizing aspects of thepresent invention on a display screen.

FIG. 18 illustrates a flow diagram of a method for providing auxiliaryviewing modes that correspond to device control modes in a medicalrobotic system, utilizing aspects of the present invention.

DETAILED DESCRIPTION

FIG. 1 illustrates, as an example, a top view of an operating room inwhich a medical robotic system 100 is being utilized by a Surgeon 20 forperforming a medical procedure on a Patient 40 who is lying face up onan operating table 50. One or more Assistants 30 may be positioned nearthe Patient 40 to assist in the procedure while the Surgeon 20 performsthe procedure teleoperatively by manipulating input devices 108, 109 ona surgeon console 10.

In the present example, an entry guide (EG) 200 is inserted through asingle entry aperture 150 into the Patient 40. Although the entryaperture 150 is a minimally invasive incision in the present example, inthe performance of other medical procedures, it may instead be a naturalbody orifice. The entry guide 200 is held and manipulated by a roboticarm assembly 130 that is mounted to a support 120.

As with other parts of the medical robotic system 100, the illustrationof the robotic arm assembly 130 is simplified in FIG. 1 . In one exampleof the medical robotic system 100, the robotic arm assembly 130 includesa setup arm and an entry guide manipulator. The setup arm is used toposition the entry guide 200 at the entry aperture 150 so that itproperly enters the entry aperture 150. The entry guide manipulator isthen used to robotically insert and retract the entry guide 200 into andout of the entry aperture 150. It may also be used to robotically pivotthe entry guide 200 in pitch, roll and yaw about a pivot point locatedat the entry aperture 150. An example of such an entry guide manipulatoris the entry guide manipulator 202 of FIG. 2 and an example of the fourdegrees-of-freedom movement that it manipulates the entry guide 200 withis shown in FIG. 5 .

The console 10 includes a 3-D monitor 104 for displaying a 3-D image ofa surgical site to the Surgeon, left and right hand-manipulatable inputdevices 108, 109, and a processor (also referred to herein as a“controller”) 102. The input devices 108, 109 may include any one ormore of a variety of input devices such as joysticks, gloves,trigger-guns, hand-operated controllers, or the like. Other inputdevices that are provided to allow the Surgeon to interact with themedical robotic system 100 include a foot pedal 105, a conventionalvoice recognition system 160 and a Graphical User Interface (GUI) 170.

An auxiliary display screen 140 is coupled to the console 10 (andprocessor 102) for providing auxiliary views to the Surgeon tosupplement those shown on the monitor 104. A second auxiliary displayscreen 140′ is also coupled to the console 10 (and processor 102) forproviding auxiliary views to the Assistant(s). An input device 180 isalso coupled to the console to allow the Assistant(s) to select betweenavailable auxiliary views for display on the second auxiliary displayscreen 140′.

The console 10 is usually located in the same room as the Patient sothat the Surgeon may directly monitor the procedure, is physicallyavailable if necessary, and is able to speak to the Assistant(s)directly rather than over the telephone or other communication medium.However, it will be understood that the Surgeon can also be located in adifferent room, a completely different building, or other remotelocation from the Patient allowing for remote surgical procedures. Insuch a case, the console 10 may be connected to the second auxiliarydisplay screen 140′ and input device 180 through a network connectionsuch as a local area network, wide area network, or the Internet.

As shown in FIGS. 3-4 , the entry guide 200 has articulatableinstruments such as articulatable surgical tools 231, 241 and anarticulatable stereo camera 211 extending out of its distal end.Although only two tools 231, 241 are shown, the entry guide 200 mayguide additional tools as required for performing a medical procedure ata work site in the Patient. For example, as shown in FIG. 4 , a passage351 is available for extending another articulatable surgical toolthrough the entry guide 200 and out through its distal end. Each of thesurgical tools 231, 241 is associated with one of the input devices 108,109 in a tool following mode. The Surgeon performs a medical procedureby manipulating the input devices 108, 109 so that the controller 102causes corresponding movement of their respectively associated surgicaltools 231, 241 while the Surgeon views the work site in 3-D on theconsole monitor 104 as images of the work site are being captured by thearticulatable camera 211.

Preferably, input devices 108, 109 will be provided with at least thesame degrees of freedom as their associated tools 231, 241 to providethe Surgeon with telepresence, or the perception that the input devices108, 109 are integral with the tools 231, 241 so that the Surgeon has astrong sense of directly controlling the tools 231, 241. To this end,the monitor 104 is also positioned near the Surgeon's hands so that itwill display a projected image that is oriented so that the Surgeonfeels that he or she is actually looking directly down onto the worksite and images of the tools 231, 241 appear to be located substantiallywhere the Surgeon's hands are located.

In addition, the real-time image on the monitor 104 is preferablyprojected into a perspective image such that the Surgeon can manipulatethe end effectors 331, 341 of the tools 231, 241 through theircorresponding input devices 108, 109 as if viewing the work site insubstantially true presence. By true presence, it is meant that thepresentation of an image is a true perspective image simulating theviewpoint of an operator that is physically manipulating the endeffectors 331, 341. Thus, the processor 102 may transform thecoordinates of the end effectors 331, 341 to a perceived position sothat the perspective image being shown on the monitor 104 is the imagethat the Surgeon would see if the Surgeon was located directly behindthe end effectors 331, 341.

The processor 102 performs various functions in the system 100. Oneimportant function that it performs is to translate and transfer themechanical motion of input devices 108, 109 through control signals overbus 110 so that the Surgeon can effectively manipulate devices, such asthe tools 231, 241, camera 211, and entry guide 200, that areselectively associated with the input devices 108, 109 at the time.Another function is to perform various methods and controller functionsdescribed herein.

Although described as a processor, it is to be appreciated that theprocessor 102 may be implemented in practice by any combination ofhardware, software and firmware. Also, its functions as described hereinmay be performed by one unit or divided up among different components,each of which may be implemented in turn by any combination of hardware,software and firmware. Further, although being shown as part of or beingphysically adjacent to the console 10, the processor 102 may alsocomprise a number of subunits distributed throughout the system.

For additional details on the construction and operation of variousaspects of a medical robotic system such as described herein, see, e.g.,U.S. Pat. No. 6,493,608 “Aspects of a Control System of a MinimallyInvasive Surgical Apparatus,” and U.S. Pat. No. 6,671,581 “CameraReferenced Control in a Minimally Invasive Surgical Apparatus,” whichare incorporated herein by reference.

FIG. 2 illustrates, as an example, a block diagram of components forcontrolling and selectively associating device manipulators to the inputdevices 108, 109. Various surgical tools such as graspers, cutters, andneedles may be used to perform a medical procedure at a work site withinthe Patient. In this example, two surgical tools 231, 241 are used torobotically perform the procedure and the camera 211 is used to view theprocedure. The tools 231, 241 and camera 211 are inserted throughpassages in the entry guide 200. As described in reference to FIG. 1 ,the entry guide 200 is inserted into the Patient through entry aperture150 using the setup portion of the robotic arm assembly 130 andmaneuvered by the entry guide manipulator (EGM) 202 of the robotic armassembly 130 towards the work site where the medical procedure is to beperformed.

Each of the devices 231, 241, 211, 200 is manipulated by its ownmanipulator. In particular, the camera 211 is manipulated by a cameramanipulator (ECM) 212, the first surgical tool 231 is manipulated by afirst tool manipulator (PSM1) 232, the second surgical tool 241 ismanipulated by a second tool manipulator (PSM2) 242, and the entry guide200 is manipulated by an entry guide manipulator (EGM) 202. So as to notoverly encumber the figure, the devices 231, 241, 211, 200 are notshown, only their respective manipulators 232, 242, 212, 202 are shownin the figure.

Each of the instrument manipulators 232, 242, 212 is a mechanicalassembly that carries actuators and provides a mechanical, sterileinterface to transmit motion to its respective articulatable instrument.Each instrument 231, 241, 211 is a mechanical assembly that receives themotion from its manipulator and, by means of a cable transmission,propagates the motion to its distal articulations (e.g., joints). Suchjoints may be prismatic (e.g., linear motion) or rotational (e.g., theypivot about a mechanical axis). Furthermore, the instrument may haveinternal mechanical constraints (e.g., cables, gearing, cams, belts,etc.) that force multiple joints to move together in a pre-determinedfashion. Each set of mechanically constrained joints implements aspecific axis of motion, and constraints may be devised to pairrotational joints (e.g., joggle joints). Note also that in this way theinstrument may have more joints than the available actuators.

In contrast, the entry guide manipulator 202 has a differentconstruction and operation. A description of the parts and operation ofthe entry guide manipulator 202 is described below in reference to FIG.7 .

In this example, each of the input devices 108, 109 may be selectivelyassociated with one of the devices 211, 231, 241, 200 so that theassociated device may be controlled by the input device through itscontroller and manipulator. For example, by placing switches 258, 259respectively in tool following modes “T2” and “T1”, the left and rightinput devices 108, 109 may be respectively associated with the first andsecond surgical tools 231, 241, which are telerobotically controlledthrough their respective controllers 233, 243 (preferably implemented inthe processor 102) and manipulators 232, 242 so that the Surgeon mayperform a medical procedure on the Patient while the entry guide 200 islocked in place.

When the camera 211 or the entry guide 200 is to be repositioned by theSurgeon, either one or both of the left and right input devices 108, 109may be associated with the camera 211 or entry guide 200 so that theSurgeon may move the camera 211 or entry guide 200 through itsrespective controller (213 or 203) and manipulator (212 or 202). In thiscase, the disassociated one(s) of the surgical tools 231, 241 is lockedin place relative to the entry guide 200 by its controller. For example,by placing switches 258, 259 respectively in camera positioning modes“C2” and “C1”, the left and right input devices 108, 109 may beassociated with the camera 211, which is telerobotically controlledthrough its controller 213 (preferably implemented in the processor 102)and manipulator 212 so that the Surgeon may position the camera 211while the surgical tools 231, 241 and entry guide 200 are locked inplace by their respective controllers 233, 243, 203. If only one inputdevice is to be used for positioning the camera, then only one of theswitches 258, 259 is placed in its camera positioning mode while theother one of the switches 258, 259 remains in its tool following mode sothat its respective input device may continue to control its associatedsurgical tool.

On the other hand, by placing switches 258, 259 respectively in entryguide positioning modes “G2” and “G1”, the left and right input devices108, 109 may be associated with the entry guide 200, which istelerobotically controlled through its controller 203 (preferablyimplemented in the processor 102) and manipulator 202 so that theSurgeon may position the entry guide 200 while the surgical tools 231,241 and camera 211 are locked in place relative to the entry guide 200by their respective controllers 233, 243, 213. As with the camerapositioning mode, if only one input device is to be used for positioningthe entry guide, then only one of the switches 258, 259 is placed in itsentry guide positioning mode while the other one of the switches 258,259 remains in its tool following mode so that its respective inputdevice may continue to control its associated surgical tool.

The selective association of the input devices 108, 109 to other devicesin this example may be performed by the Surgeon using the GUI 170 or thevoice recognition system 160 in a conventional manner. Alternatively,the association of the input devices 108, 109 may be changed by theSurgeon depressing a button on one of the input devices 108, 109 ordepressing the foot pedal 105, or using any other well known modeswitching technique.

FIGS. 3-4 respectively illustrate, as examples, top and right side viewsof a distal end of the entry guide 200 with the camera 211 and surgicaltools 231, 241 extending outward. As shown in a perspective view of asimplified (not to scale) entry guide 200 in FIG. 5 , the entry guide200 is generally cylindrical in shape and has a longitudinal axis X′running centrally along its length. The pivot point, which is alsoreferred to as a remote center “RC”, serves as an origin for both afixed reference frame having X, Y and Z axes as shown and an entry guidereference frame having X′, Y′ and Z′ axes as shown. When the system 100is in the entry guide positioning mode, the entry guide manipulator 202is capable of pivoting the entry guide 200 in response to movement ofone or more associated input devices about the Z axis (which remainsfixed in space) at the remote center “RC” in yaw ψ. In addition, theentry guide manipulator 202 is capable of pivoting the entry guide 200in response to movement of the one or more input devices about the Y′axis (which is orthogonal to the longitudinal axis X′ of the entry guide200) in pitch θ, capable of rotating the entry guide 200 about itslongitudinal axis X′ in roll Φ, and linearly moving the entry guide 200along its longitudinal axis X′ in insertion/retraction or in/out “I/O”directions in response to movement of the one or more associated inputdevices. Note that unlike the Z-axis which is fixed in space, the X′ andY′ axes move with the entry guide 200.

As shown in FIG. 7 , the entry guide manipulator (EGM) 202 has fouractuators 701-704 for actuating the four degrees-of-freedom movement ofthe entry guide 200 (i.e., pitch θ, yaw ψ, roll Φ, and in/out I/O) andfour corresponding assemblies 711-714 to implement them.

Referring back to FIGS. 3-4 , the articulatable camera 211 extendsthrough passage 321 and the articulatable surgical tools 231, 241respectively extend through passages 431, 441 of the entry guide 200.The camera 211 includes a tip 311 (which houses a stereo cameraconnected to a camera controller and a fiber-optic cable connected to anexternal light source), first, second, and third links 322, 324, 326,first and second joint assemblies (also referred to herein simply as“joints”) 323, 325, and a wrist assembly 327. The first joint assembly323 couples the first and second links 322, 324 and the second jointassembly 325 couples the second and third links 324, 326 so that thesecond link 324 may pivot about the first joint assembly 323 in pitchand yaw while the first and third links 322, 326 remain parallel to eachother.

The first and second joints 323, 325 are referred to as “joggle joints”,because they cooperatively operate together so that as the second link324 pivots about the first joint 323 in pitch and/or yaw, the third link326 pivots about the second joint 325 in a complementary fashion so thatthe first and third links 322, 326 always remain parallel to each other.The first link 322 may also rotate around its longitudinal axis in rollas well as move in and out (e.g., insertion towards the work site andretraction from the worksite) through the passage 321. The wristassembly 327 also has pitch and yaw angular movement capability so thatthe camera's tip 311 may be oriented up or down and to the right orleft, and combinations thereof.

The joints and links of the tools 231, 241 are similar in constructionand operation to those of the camera 211. In particular, the tool 231includes an end effector 331 (having jaws 338, 339), first, second, andthird links 332, 334, 336, first and second joint assemblies 333, 335,and a wrist assembly 337 that are driven by actuators such as describedin reference to FIG. 8 (plus an additional actuator for actuating theend effector 331). Likewise, the tool 241 includes an end effector 341(having jaws 348, 349), first, second, and third links 342, 344, 346,first and second joint assemblies 343,345, and a wrist assembly 347 thatare also driven by actuators such as described in reference to FIG. 8(plus an additional actuator for actuating the end effector 341).

FIG. 8 illustrates, as an example, a diagram of interacting parts of anarticulatable instrument (such as the articulatable camera 211 and thearticulatable surgical tools 231, 241) and its corresponding instrumentmanipulator (such as the camera manipulator 212 and the toolmanipulators 232, 242). Each of the instruments includes a number ofactuatable assemblies 821-823, 831-833, 870 for effectuatingarticulation of the instrument (including its end effector), and itscorresponding manipulator includes a number of actuators 801-803,811-813, 860 for actuating the actuatable assemblies.

In addition, a number of interface mechanisms may also be provided. Forexample, pitch/yaw coupling mechanisms 840, 850 (respectively for thejoggle joint pitch/yaw and the wrist pitch/yaw) and gear ratios 845, 855(respectively for the instrument roll and the end effector actuation)are provided in a sterile manipulator/instrument interface to achievethe required range of motion of the instrument joints in instrumentjoint space while both satisfying compactness constraints in themanipulator actuator space and preserving accurate transmissions ofmotion across the interface. Although shown as a single block 840, thecoupling between the joggle joint actuators 801, 802 (differentiated as#1 and #2) and joggle joint pitch/yaw assemblies 821, 822 may include apair of coupling mechanisms—one on each side of the sterile interface(i.e., one on the manipulator side of the interface and one on theinstrument side of the interface). Likewise, although shown as a singleblock 850, the coupling between the wrist actuators 812, 813(differentiated as #1 and #2) and wrist pitch/yaw joint assemblies 832,833 may also comprise a pair of coupling mechanisms—one on each side ofthe sterile interface.

Both the joggle joint pitch assembly 821 and the joggle joint yawassembly 822 share the first, second and third links (e.g., links 322,324, 326 of the articulatable camera 211) and the first and secondjoints (e.g., joints 322, 325 of the articulatable camera 211). Inaddition to these shared components, the joggle joint pitch and yawassemblies 821, 822 also include mechanical couplings that couple thefirst and second joints (through joggle coupling 840) to the jogglejoint pitch and yaw actuators 801, 802 so that the second link maycontrollably pivot about a line passing through the first joint andalong an axis that is latitudinal to the longitudinal axis of the firstlink (e.g., link 322 of the articulatable camera 211) and the secondlink may controllably pivot about a line passing through the first jointand along an axis that is orthogonal to both the latitudinal andlongitudinal axes of the first link.

The in/out (I/O) assembly 823 includes the first link (e.g., link 322 ofthe articulatable camera 211) and interfaces through a drive traincoupling the in/out (I/O) actuator 803 to the first link so that thefirst link is controllably moved linearly along its longitudinal axis byactuation of the I/O actuator 803. The roll assembly 831 includes thefirst link and interfaces through one or more gears (i.e., having thegear ratio 845) that couple a rotating element of the roll actuator 811(such as a rotor of a motor) to the first link so that the first link iscontrollably rotated about its longitudinal axis by actuation of theroll actuator 811.

The instrument manipulator (e.g., camera manipulator 212) includes wristactuators 812, 813 that actuate through wrist coupling 850 pitch and yawjoints 832, 833 of the wrist assembly (e.g., wrist 327 of thearticulatable camera 211) so as to cause the instrument tip (e.g.,camera tip 311) to controllably pivot in an up-down (i.e., pitch) andside-to-side (i.e., yaw) directions relative to the wrist assembly. Thegrip assembly 870 includes the end effector (e.g., end effector 331 ofthe surgical tool 231) and interfaces through one or more gears (i.e.,having the gear ratio 855) that couple the grip actuator 860 to the endeffector so as to controllably actuate the end effector.

FIG. 9 illustrates, as an example, a flow diagram of a methodimplemented in controller 102 of the medical robotic system 100 forproviding a computer generated auxiliary view including articulatableinstruments, such as the articulatable camera 211 and/or one or more ofthe articulatable surgical tools 231, 241, extending out of the distalend of the entry guide 200. For the purposes of this example, it isassumed that the articulatable camera 211 and surgical tools 231, 241extend out of the distal end of the entry guide 200 and are included inthe auxiliary view. However, it is to be appreciated that the method isapplicable to any combination of articulatable instruments, includingthose without an articulatable camera and/or those with an alternativetype of image capturing device such as an ultrasound probe.

In 901, the method determines whether or not an auxiliary view is to begenerated. If the determination in 901 is NO, then the method loops backto periodically check to see whether the situation has changed. On theother hand, if the determination in 901 is YES, then the method proceedsto 902. The indication that an auxiliary view is to be generated may beprogrammed into the controller 102, created automatically or created byoperator command.

In 902, the method receives state information, such as positions andorientations, for each of the instruments 211, 231, 241 and the entryguide 200. This information may be provided by encoders coupled to theactuators in their respective manipulators 212, 232, 242, 202.Alternatively, the information may be provided by sensors coupled tojoints and/or links of the instruments 211, 231, 241 and the entry guidemanipulator 202, or the coupling mechanisms, gears and drive trains ofthe interface between corresponding manipulators and instruments, so asto measure their movement. In this second case, the sensors may beincluded in the instruments 211, 231, 241 and entry guide manipulator202 such as rotation sensors that sense rotational movement of rotaryjoints and linear sensors that sense linear movement of prismatic jointsin the instruments 211, 231, 241 and entry guide manipulator 202. Othersensors may also be used for providing information of the positions andorientations of the instruments 211, 231, 241 and entry guide 200 suchas external sensors that sense and track trackable elements, which maybe active elements (e.g., radio frequency, electromagnetic, etc.) orpassive elements (e.g., magnetic, etc.), placed at strategic points onthe instruments 211, 231, 241, the entry guide 200 and/or the entryguide manipulator 202 (such as on their joints, links and/or tips).

In 903, the method generates a three-dimensional computer model of thearticulatable camera 211 and articulatable surgical tools 231, 241extending out of the distal end of the entry guide 200 using theinformation received in 902 and the forward kinematics and knownconstructions of the instruments 211, 231, 241, entry guide 200, andentry guide manipulator 202. The generated computer model in thisexample may be referenced to the remote center reference frame (X, Y, Zaxes) depicted in FIG. 5 . Alternatively, the generated computer modelmay be referenced to a reference frame defined at the distal end of theentry guide 200. In this latter case, if the orientation and extensionof the entry guide 200 from the remote center does not have to beaccounted for in the auxiliary view that is being generated by themethod, then the position and orientation information for the entryguide 200 may be omitted in 902.

For example, referring to FIG. 10 , if the state information received in902 is the instruments' joint positions 1001, such as from sensors 1010,then this information may be applied to the instruments' forwardkinematics 1002 using the instruments' kinematic models 1003 to generatethe instruments' link positions and orientations 1005 relative toreference frame 1004. The same process may also be generally applied ifthe state information received in 902 is sensed states of the jogglecoupling and gear mechanisms in the manipulator/instrument interfaces.

On the other hand, referring to FIG. 11 , if the state informationreceived in 902 is the instruments' tip positions 1101 (in the referenceframe 1004), such as from sensors 1110, then this information may beapplied to the instruments' inverse kinematics 1102 using theinstruments' kinematic models 1003 and the sensor reference frame togenerate the instruments' joint positions 1001. The instruments' jointpositions 1001 may then be applied as described in reference to FIG. 10to generate the instruments' link positions and orientations 1005relative to reference frame 1004.

Alternatively, also referring to FIG. 11 , if the state informationprovided in 902 is limited to only the camera's tip position, then thepositions of the tips of the surgical tools 231, 241 may be determinedrelative to the camera reference frame by identifying the tips in theimage captured by the camera 211 using conventional image processingtechniques and then translating their positions to the reference frame1004, so that the positions of the camera and tool tips may be appliedas described in reference to FIGS. 10, 11 to generate the instruments'link positions and orientations 1005 relative to the reference frame1004.

In 904, the method adjusts the view of the computer model of thearticulatable camera 211 and articulatable surgical tools 231, 241extending out of the distal end of the entry guide 200 in thethree-dimensional space of the reference frame to a specified viewingpoint (wherein the term “viewing point” is to be understood herein toinclude position and orientation). For example, FIG. 12 illustrates atop view of the articulatable camera 211 and articulatable surgicaltools 231, 241 extending out of the distal end of the entry guide 200which corresponds to a viewing point above and slightly behind thedistal end of the entry guide 200. As another example, FIG. 13illustrates a side view of the articulatable camera 211 andarticulatable surgical tools 231, 241 extending out of the distal end ofthe entry guide 200 which corresponds to a viewing point to the rightand slightly in front of the distal end of the entry guide 200. Notethat although the auxiliary views depicted in FIGS. 12-13 aretwo-dimensional, they may also be three-dimensional views sincethree-dimensional information is available from the generated computermodel. In this latter case, the auxiliary display screen 140 that theyare being displayed on would have to be a three-dimensional displayscreen like the monitor 104.

The viewing point may be set at a fixed point such as one providing anisometric (three-dimensional) view from the perspective shown in FIG. 12. This perspective provides a clear view to the surgeon of thearticulatable camera 211 and the articulatable surgical tools 231, 241when the tools 231, 241 are bent “elbows out” as shown (which is atypical configuration for performing a medical procedure using thesurgical tools 231, 241). On the other hand, when a third surgical toolis being used (e.g., inserted in the passage 351 shown in FIG. 6 ), aside view from the perspective of FIG. 13 may additionally be usefulsince the third surgical tool may be beneath the articulatable camera211 and therefore obscured by it in the perspective shown in FIG. 12 .

Rather than setting the viewing point to a fixed point at all times, theviewing point may also be automatically changed depending upon thecontrol mode (i.e., one of the modes described in reference to FIG. 2 )that is operative at the time. As an example, FIG. 18 illustrates amethod for automatically changing the auxiliary viewing mode dependingupon the control mode currently operative in the medical robotic system100. In particular, using this method, a first auxiliary viewing mode isperformed in 1802 when the medical robotic system 100 is determined in1801 to be in a tool following mode, a second auxiliary viewing mode isperformed in 1804 when the medical robotic system 100 is determined in1803 to be in an entry guide positioning mode, and a third auxiliaryviewing mode is performed in 1806 when the medical robotic system 100 isdetermined in 1805 to be in a camera positioning mode. The viewing modesfor each control mode are selected so as to be most beneficial to thesurgeon for performing actions during that mode. For example, in thetool following and camera positioning modes, either or both the surgicaltools 231, 241 and camera 211 is being moved at the time and therefore,an auxiliary view of the articulatable camera 211 and articulatablesurgical tools 231, 241 extending out of the distal end of the entryguide 200, such as depicted in FIGS. 12 and 13 , is useful to avoidcollisions between links that are out of the field of view of the camera211. On the other hand, in the entry guide positioning mode, thearticulatable camera 211 and the articulatable surgical tools 231, 241are locked in position relative to the entry guide 200 and therefore, anauxiliary view providing information on other things such as depicted inFIGS. 16 and 17 may be useful.

Alternatively, operator selectable means for changing the viewing pointduring the performance of a medical procedure may be provided. Forexample, the GUI 170 or voice recognition system 160 may be adapted toprovide an interactive means for the Surgeon to select the viewing modeand/or change the viewing point of an auxiliary view of thearticulatable camera 211 and/or articulatable surgical tools 231, 241 asthey extend out of the distal end of the entry guide 200. Buttons on theinput devices 108, 109 or the foot pedal 105 may also be used forSurgeon selection of viewing modes. For the Assistant(s), the inputdevice 180 may be used along with a GUI associated with the displayscreen 140′ for selection of viewing modes. Thus, the viewing modes thatthe Surgeon and Assistant(s) see at the time may be optimized for theirparticular tasks at the time. Examples of such operator selectableviewing modes and viewing angles are depicted in FIGS. 12-17 .

In 905, the method renders the computer model. Rendering in this caseincludes adding three-dimensional qualities such as known constructionfeatures of the instruments 211, 231, 241 and the distal end of theentry guide 200 to the model, filling-in any gaps to make solid models,and providing natural coloring and shading. In addition, rendering mayinclude altering the color or intensity of one or more of theinstruments 211, 231, 241 (or one or more of their joints or links orportions thereof) so that the instrument (or joint or link or portionthereof) stands out for identification purposes.

Alternatively, the altering of the color, intensity, or frequency ofblinking on and off (e.g., flashing) of one or more of the instruments211, 231, 241 (or their joints, links, or portions thereof) may serve asa warning that the instrument (or joint or link or portion thereof) isapproaching an undesirable event or condition such as nearing a limit ofits range of motion or getting too close to or colliding with anotherone of the instruments. When color is used as a warning, the color maygo from a first color (e.g., green) to a second color (e.g., yellow)when a warning threshold of an event to be avoided (e.g., range ofmotion limitation or collision) is reached, and from the second color toa third color (e.g., red) when the event to be avoided is reached. Whenintensity is used as a warning, the intensity of the color changes asthe instrument (or portion thereof) moves past the warning thresholdtowards the event to be avoided with a maximum intensity provided whenthe event is reached. When blinking of the color is used as a warning,the frequency of blinking changes as the instrument (or portion thereof)moves past the warning threshold towards the event to be avoided with amaximum frequency provided when the event is reached. The warningthreshold may be based upon a range of motion of the instrument (orportion thereof, such as its joints) or upon a distance between theinstrument (or portion thereof) and another instrument (or portionthereof) that it may collide with. Velocity of the instrument's movementmay also be a factor in determining the warning threshold. The warningthreshold may be programmed by the operator, using the GUI 170, forexample, or determined automatically by a programmed algorithm in theprocessor 102 that takes into account other factors such as the velocityof the instruments' movements.

Alternatively, the altering of the color, intensity, or frequency ofblinking on and off (e.g., flashing) of one or more of the instruments211, 231, 241 (or their joints, links, or portions thereof) may serve asan alert that the instrument (or joint or link or portion thereof) isapproaching a desirable event or condition such as an optimal positionor configuration for performing or viewing a medical procedure. In thiscase, an alert threshold may be defined so that the color, intensity,and/or blinking of the one or more of the instruments 211, 231, 241 (ortheir joints, links, or portions thereof) may change in a similar manneras described previously with respect to warning thresholds andundesirable events or conditions, except that in this case, the changestarts when the alert threshold is reached and maximizes or otherwiseends when the desirable event or condition is reached or otherwiseachieved. The alert threshold may also be programmed by the operator ordetermined automatically by a programmed algorithm in a conceptuallysimilar manner as the warning threshold.

As an example of such highlighting of an instrument for identification,warning or alerting purposes, FIG. 15 shows an auxiliary view of thecamera 211 and surgical tools 231, 241 in a window 1502, where thecamera 211 has been highlighted. As an example of such highlighting ofjoints of instruments for identification, warning or alerting purposes,FIG. 12 shows joints of the surgical tools 231, 241 that have beenhighlighted. As an example of highlighting portions of instruments forwarning purposes, FIG. 14 shows a portion 1402 of the surgical tool 241and a portion 1403 of the camera 211 highlighted to indicate that theseportions are dangerously close to colliding.

Rendering may also include overlaying the image captured by the camera211 over the auxiliary view when the viewing point of the auxiliaryimage is the same as or directly behind that of the camera 211. As anexample, FIG. 17 illustrates a captured image 1700 of the camera 211rendered as an overlay to an auxiliary view of surgical tools 231, 241which has been generated from a viewing point of (or right behind) thecamera 211. In this example, the auxiliary view of the surgical tools231, 241 being displayed on the auxiliary display screen 140 (and/or theauxiliary display screen 140′) includes portions (e.g., 1731, 1741) inthe overlaying captured image 1700 and portions (e.g., 1732, 1742)outside of the overlaying captured image 1700. Thus, the portions of thesurgical tools 231, 241 outside of the captured image 1700 provide theSurgeon with additional information about their respective links orarticulating arms that are out of the field of view of the camera 211.Highlighting of the instrument portions (e.g., 1732, 1742) outside ofthe captured image 1700 may also be done for identification purposes orto indicate a warning or alerting condition as described above.Overlaying the captured image 1700 onto the auxiliary view also has theadvantage in this case of showing an anatomic structure 360 which is infront of the surgical tools 231, 241 that would not otherwise normallybe in the auxiliary view. Although this example shows the captured image1700 overlaying the auxiliary view on the auxiliary display screen 140,in another rendering scheme, the auxiliary view may overlay the capturedimage that is being displayed on the monitor 104.

Rather than overlaying the captured image, rendering may also includeusing the auxiliary view to augment the image captured by the camera 211by displaying only the portions of the instruments 231, 241 that are notseen in the captured image (i.e., the dotted line portion of theinstruments 231, 241 in FIG. 17 ) in proper alignment and adjacent thecaptured image in a mosaic fashion.

In addition to, or in lieu of, overlaying the captured image over theauxiliary view or augmenting the captured image with the auxiliary view,rendering may also include providing other useful information in theauxiliary view. As an example, FIG. 16 illustrates an auxiliary sideview of an articulatable camera 211 with a frustum 1601 rendered on theauxiliary view so as to be displayed on the auxiliary display 140 asemanating from, and moving with, the camera tip 311. Note that althoughthe frustum 1601 is shown in the figure as a truncated cone, it may alsoappear as a truncated pyramid to correspond to the captured image thatis shown on the monitor 104. The sides of the frustum 1601 indicate aviewing range of the camera 211 and the base 1602 of the frustum 1601displays an image 1650 that was captured by the camera 211. Note thatfor simplification purposes, the surgical tools 231, 241 normally in theauxiliary view have been removed for this example. As another example,FIG. 14 shows a semi-translucent sphere or bubble 1401 (preferablycolored red) which is displayed by the method as part of the renderingprocess when a warning threshold is reached so as to indicate to theoperator that the highlighted portions 1402, 1403 of the surgical tool241 and camera 211 are dangerously close to colliding. In this case, thehighlighted portions 1402, 1403 are preferably centered within thesphere. As yet another example, FIG. 14 also shows a marker or otherindicator 1410 indicating an optimal position for the camera tip 311 forviewing the end effectors of the surgical tools 231, 241 as they arebeing used to perform a medical procedure. The optimal position may bedetermined, for example, by finding a location where the tips of the endeffectors are equidistant from a center of the captured image. Asanother example, an auxiliary view is generated by the processor 102being programmed to: generate a computer model by using stateinformation of a plurality of instruments, e.g., camera 211 and surgicaltools 231, 241, that are extending out of the entry guide 200; andadjust a view of the computer model to a perspective of a fixed viewingpoint which is different than a viewing point for an image presentlycapturable by the camera 211. The processor 102 further being programmedto: calculate a centroid for the plurality of instruments; and cause thecentroid to be displayed on the display 140 (or monitor 104) along withthe adjusted view of the computer model so as to provide an indicationof whether the entry guide 200 needs to be repositioned.

In 906, the method causes the rendered computer model (i.e., theauxiliary view) to be displayed on one or more displayed screens (e.g.,140 and 140′) from the perspective of the selected viewing point. Asshown in FIGS. 12-14 and 16-17 , the auxiliary view is displayed on theauxiliary display screen 140. As shown in FIG. 14 , more than oneauxiliary view may be displayed at one time (e.g., top and sideperspectives may be provided at the same time respectively in windows1421 and 1422). As shown in FIG. 15 , the auxiliary view may also bedisplayed on the primary monitor 104 in a window 1502 that is adjacentto an image captured by the articulatable camera 211 which is beingshown in another window 1501. Although the windows 1501 and 1502 appearin this example to be the same size, it is to be appreciated that theposition and size of the auxiliary view window 1502 may vary and stillbe within the scope of the present invention. Also, as previouslymentioned, the auxiliary view may be overlayed the captured image in thewindow 1501 instead of in its own separate window 1502. In such case,the overlayed auxiliary view may be switched on and off by the Surgeonso as not to clutter the captured image during the performance of amedical procedure. The switching on and off in this case may beperformed by depressing a button on one of the input devices 108, 109 ordepressing the foot pedal 105. Alternatively, it may be done by voiceactivation using the voice recognition system 160 or through Surgeoninteraction with the GUI 170 or using any other conventional functionswitching means.

After completing 906, the method then loops back to 901 to repeat901-906 for the next processing cycle of the controller 102.

Although the various aspects of the present invention have beendescribed with respect to a preferred embodiment, it will be understoodthat the invention is entitled to full protection within the full scopeof the appended claims.

We claim:
 1. A medical system comprising: a display; and a processorconfigured to: determine an optimal position for an image capturinginstrument to view working ends of a plurality of medical instrumentswhen the plurality of medical instruments and the image capturinginstrument are each extending out of a distal end of an entry guide; andcause the optimal position to be displayed on the display along with animage captured by the image capturing instrument of the working ends ofthe plurality of medical instruments.
 2. The medical system according toclaim 1, wherein the processor is further configured to: determine theoptimal position for the image capturing instrument to view the workingends of the plurality of medical instruments by finding a location wherethe working ends of the plurality of medical instruments are equidistantfrom a center of the image presently capturable by the image capturinginstrument.
 3. The medical system according to claim 1, wherein theprocessor is further configured to: generate a computer model of theplurality of medical instruments by using state information from aplurality of sensors adapted to generate the state information bysensing states of the plurality of medical instruments; adjust a view ofthe computer model to a perspective of a first viewing point which isdifferent than a viewing point for an image presently capturable by theimage capturing instrument; and cause the adjusted view of the computermodel to be displayed on the display in a separate window than the imagecaptured by the image capturing instrument of the working ends of theplurality of medical instruments.
 4. A method comprising: a processordetermining an optimal position for an image capturing instrument toview working ends of a plurality of medical instruments when theplurality of medical instruments and the image capturing instrument areeach extending out of a distal end of an entry guide; and the processorcausing the optimal position to be displayed on a display along with animage captured by the image capturing instrument of the working ends ofthe plurality of medical instruments.
 5. The method according to claim4, wherein the processor determines the optimal position for the imagecapturing instrument to view the working ends of the plurality ofmedical instruments by: the processor determining a location where theworking ends of the plurality of medical instruments are equidistantfrom a center of the image presently capturable by the image capturinginstrument.
 6. The method according to claim 4, further comprising: theprocessor receiving state information from a plurality of sensorsadapted to generate the state information by sensing states of theplurality of medical instruments; the processor generating a computermodel of the plurality of medical instruments by using the stateinformation; the processor adjusting a view of the computer model to aperspective of a first viewing point which is different than a viewingpoint for an image presently capturable by the image capturinginstrument; and the processor causing the adjusted view of the computermodel to be displayed on the display in a separate window than the imagecaptured by the image capturing instrument of the working ends of theplurality of medical instruments.
 7. A method comprising: one ofproviding and receiving, first one or more processor executableinstructions to determine an optimal position for an image capturinginstrument to view working ends of a plurality of medical instrumentswhen the plurality of medical instruments and the image capturinginstrument are each extending out of a distal end of an entry guide; andone of providing and receiving, second one or more processor executableinstructions to cause the optimal position to be displayed on a displayalong with an image captured by the image capturing instrument of theworking ends of the plurality of medical instruments.
 8. The methodaccording to claim 7, wherein the first one or more processor executableinstructions includes third one or more processor executableinstructions to determine a location where the working ends of theplurality of medical instruments are equidistant from a center of theimage presently capturable by the image capturing instrument.
 9. Themethod according to claim 7, further comprising: one of providing andreceiving, fourth one or more processor executable instructions togenerate a computer model of the plurality of medical instruments byusing state information from a plurality of sensors adapted to generatethe state information by sensing states of the plurality of medicalinstruments; one of providing and receiving, fifth one or more processorexecutable instructions to adjust a view of the computer model to aperspective of a first viewing point which is different than a viewingpoint for an image presently capturable by the image capturinginstrument; and one of providing and receiving, sixth one or moreprocessor executable instructions to cause the adjusted view of thecomputer model to be displayed on the display in a separate window thanthe image captured by the image capturing instrument of the working endsof the plurality of medical instruments.